Suture-button constructs have been used for fixation of ankle syndesmosis (U.S. Pat. No. 7,235,091), acromioclavicular (AC) joint fixation (U.S. Patent Application Publication No. 2007/0179531) and more recently, for small joint surgery, such as bunion repair (U.S. Ser. No. 12/016,129, filed on Jan. 17, 2008), or lisfranc repair (U.S. Ser. No. 12/016,121, filed Jan. 17, 2008). In these small joint techniques, the suture-button construct is passed through a passage or tunnel (for example, a drilled hole) by employing a needle that pulls the button and the attached suture through the passage or tunnel. Pulling of the needle through the passage or tunnel, and subsequently out the skin, may be difficult, however, in certain circumstances, such as hallux valgus correction and lisfranc ligament repair. In addition, proper positioning of the buttons (for example, of the oblong and round button of the suture-button construct) may be difficult when the buttons are pulled through with suture and needle.
An instrument that would be able to push the buttons and attached suture through the drilled hole (instead of having to pull them through using the needle) is needed. Methods of advancing suture/button constructs through drilled tunnels or holes, particularly in situations where the needle and attached suture/button construct cannot be easily pulled through the hole and out the skin, are also needed.